Provider Demographics
NPI:1356677017
Name:BUONAGURO, GIA (GIA BUONAGURO, MFT)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:
Last Name:BUONAGURO
Suffix:
Gender:F
Credentials:GIA BUONAGURO, MFT
Other - Prefix:
Other - First Name:GIA
Other - Middle Name:
Other - Last Name:BUONAGURO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:8170 BEVERLY BLVD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4524
Mailing Address - Country:US
Mailing Address - Phone:310-499-9533
Mailing Address - Fax:
Practice Address - Street 1:8170 BEVERLY BLVD
Practice Address - Street 2:SUITE 100B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4524
Practice Address - Country:US
Practice Address - Phone:310-499-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist